金山区社区卫生服务中心住院COPD患者诊治现状调查

The preliminary research of diagnosis and treatment of hospitalized patients with chronic obstructive pulmonary disease in Jinshan District Community Health Service Centers

目的了解上海市金山区社区卫生服务中心住院慢性阻塞性肺病(COPD)患者的诊治现状,为提高基层社区COPD的诊断和规范化治疗水平提供参考依据。方法病例回顾性分析。以金山区9家社区医院2015年1—12月诊断为"慢性支气管炎、COPD及支气管哮喘"的759例住院患者为研究对象,分析全科医生诊治的规范程度。结果 759例患者平均年龄(79.69±7.52)岁,平均病程(15.94±10.79)年。99例被诊断为COPD,仅2例经上级医院行肺功能检查并确诊,COPD的漏诊率27.69%、误诊率87.27%;所有住院病人均无激素吸入治疗,静脉、口服激素治疗时间(13.43±7.48)d;几乎所有病人均应用抗生素,但应用指征和效果评估均不规范;支气管舒张剂治疗中,缺乏长效制剂应用。同时戒烟宣教缺乏。结论金山区社区医生对于COPD的认知程度普遍较低,COPD的漏诊、误诊发生率高,慢阻肺急性加重诊治不规范。

Objective：To investigate the status of diagnosis and treatment of hospitalized patients with chronic obstructive pulmonary disease（COPD）in Jinshan District community health service centers and to provide a reference basis for improving the level of diagnosis and standardized treatment of COPD. Methods：Seven hundred and fifty-nine patients with chronic bronchitis,COPD and asthma in nine community health service centers from January 1,2015 to December 31, 2015 were taken randomly as the research objects in order to know the understanding degree of community physicians about risk factors,diagnostic criteria and standardized treatment in diagnosis and treatment. Results：The mean age of 759 patients was 79. 69 ± 7. 52 years old and the mean course of disease was 15. 94 ± 10. 79 years. Only two cases in ninety-nine who were diagnosed as COPD by community physicians finished pulmonary function tests in the superior hospitals and had a definite diagnosis. By following-up pulmonary function it was found that the rate of missed diagnosis of COPD was 27. 69%and the rate of misdiagnosis of COPD was 87. 27%. Conclusion：Community physicians in Jinshan District generally lack of awareness of COPD. The rate of missed diagnosis of COPD and the rate of misdiagnosis of COPD is high. It is urgent for community physicians to popularize the related knowledge of standardized diagnosis and treatment of COPD. At the same time,suitable tools of initial screening should be spread to primary hospitals so as to improve the diagnostic rate and reduce the misdiagnosis rate.